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Parvizi J, Cha Y, Chisari E, Kim K, Koo KH. Comprehensive Guidance for the Prevention of Periprosthetic Joint Infection After Total Joint Arthroplasty and Pitfalls in the Prevention. J Korean Med Sci 2024; 39:e147. [PMID: 38651227 PMCID: PMC11035713 DOI: 10.3346/jkms.2024.39.e147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume of TJAs, there is a simultaneous rise in the incidence of PJI. Contamination of the surgical wound and the adherence of bacteria to the surface of prosthetic component represent the initial step in the pathogenesis of PJI. The main sources of the contamination are 1) patient's own flora, 2) droplets in the operation room air, and 3) surgical gloves and instruments. Even though modern techniques have markedly reduced the degree of contamination, TJAs cannot be done in completely germ-free conditions and some degree of contamination is inevitable in all surgical procedures. However, not all contamination leads to PJI. It develops when the burden of contamination exceeds the immune threshold or the colony forming units (CFUs) and various factors contribute to a decrease in the CFU level. Surgeons should be aware of the germ burden/CFU concept and should monitor sources of contamination to maintain the germ burden below the CFU to prevent PJI.
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Affiliation(s)
- Javad Parvizi
- International Joint Center, Acibadem University Hospital, Istanbul, Turkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kangbaek Kim
- Kay Joint Center at Cheil Orthopaedic Hospital, Seoul, Korea
| | - Kyung-Hoi Koo
- Kay Joint Center at Cheil Orthopaedic Hospital, Seoul, Korea
- Seoul National University Bundang Hospital, Seongnam, Korea.
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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Comparative Interrupted Time Series Analysis of Direct Medical Expense and Length of Stay in Elderly Patients with Femoral Neck Fractures Who Underwent Total Hip Arthroplasty and Hemiarthroplasty: A Real World Nationwide Database Study. Clin Orthop Surg 2024; 16:217-229. [PMID: 38562640 PMCID: PMC10973615 DOI: 10.4055/cios23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 04/04/2024] Open
Abstract
Background The objective of our study was to analyze the postoperative direct medical expenses and hospital lengths of stay (LOS) of elderly patients who had undergone either hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures and to determine the indication of THA by comparing those variables between the 2 groups by time. Methods In this comparative large-sample cohort study, we analyzed data from the 2011 to 2018 Korean National Health Insurance Review and Assessment Service database. The included patients were defined as elderly individuals aged 60 years or older who underwent HA or THA for a femoral neck fracture. A 1:1 risk-set matching was performed on the propensity score, using a nearest-neighbor matching algorithm with a maximum caliper of 0.01 of the hazard components. In comparative interrupted time series analysis, time series were constructed using the time unit of one-quarter before and after 3 years from time zero. For the segmented regression analysis, we utilized a generalized linear model with a gamma distribution and logarithmic link function. Results A total of 4,246 patients who received THA were matched and included with 4,246 control patients who underwent HA. Although there was no statistically significant difference in direct medical expense and hospital LOS for the first 6 months after surgery, direct medical expenses and hospital LOS in THA were relatively reduced compared to the HA up to 24 months after surgery (p < 0.05). In the subgroup analysis, the THA group's hospital LOS decreased significantly compared to that of the HA group during the 7 to 36 months postoperative period in the 65 ≤ age < 80 age group (p < 0.05). Direct medical expenses of the THA group significantly decreased compared to those of the HA group during the period from 7 to 24 months after surgery in the men group (p < 0.05). Conclusions When performing THA in elderly patients with femoral neck fractures, the possibility of survival for at least 2 years should be considered from the perspective of medical expense and medical utilization. Additionally, in healthy and active male femoral neck fracture patients under the age of 80 years, THA may be more recommended than HA.
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Affiliation(s)
- Seung-Hoon Kim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Korea
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Yoo JI, Cha Y, Kim JT, Park CH, Choy W, Koo KH. Comments on the Article "Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions": In Reply. Clin Orthop Surg 2024; 16:344-345. [PMID: 38562626 PMCID: PMC10973621 DOI: 10.4055/cios23323re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cha Y, Chung JY, Kim JW, Yoo JI, Lee W, Kim JT. Digital Templating of Hip Arthroplasty Using Microsoft PowerPoint: A Pilot Study with Technical Details. Bioengineering (Basel) 2024; 11:327. [PMID: 38671749 PMCID: PMC11048024 DOI: 10.3390/bioengineering11040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Templating is essential in hip arthroplasty preparation, facilitating implant size prediction and surgical rehearsal. It ensures the selection of suitable implants according to patient anatomy and disease, aiming to minimize post-operative complications. Various templating methods exist, including traditional acetate templating on both analog and digital images, alongside digital templating on digital images, which is categorized into 2D and 3D approaches. Despite the popularity of acetate templating on digital images, challenges such as the requirement for physical templates and result preservation persist. To address these limitations, digital templating with software like OrthoSize and Orthoview has been suggested, although not universally accessible. This technical note advocates for Microsoft PowerPoint as an effective alternative for 2D digital templating, highlighting its user-friendly features for image manipulation without needing specialized software. The described method involves scanning acetate templates, adjusting the images in PowerPoint 365 for size, position, and calibration on patient radiographs, and demonstrating reliability through preliminary assessments, with intraclass correlation coefficient (ICC) values indicating a high level of agreement for cup and stem size (ICC = 0.860, 0.841, respectively) but moderate for neck length (ICC = 0.592). We have introduced a method for performing 2D digital templating in the clinical field without the need for specialized software dedicated to digital templating. We believe this method significantly improves the accessibility to 2D digital templating, which was previously limited by the need for digital templating software. Additionally, it enables surgeons to easily establish arthroplasty plans and share them, overcoming the limitations of acetate templates.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Woohyun Lee
- Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
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Cha Y, Lee J, Choy W, Lee JS, Lee HH, Chae DS. Pathophysiology and Treatment of Gout Arthritis; including Gout Arthritis of Hip Joint: A Literature Review. Hip Pelvis 2024; 36:1-11. [PMID: 38420734 DOI: 10.5371/hp.2024.36.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 03/02/2024] Open
Abstract
Gout is triggered by the accumulation of uric acid in the body, leading to hyperuricemia. Genetic, metabolic, and environmental factors can influence this condition. Excessive uric acid buildup results in the formation of monosodium urate (MSU) crystals, which precipitate in specific areas of the body, including the joints, where they can cause symptoms of gout. While the acute and chronic symptoms of gout have been well-documented, diagnosis of gout affecting the hip joint poses significant challenges. The global incidence of gout, the most prevalent form of inflammatory arthritis, is on the rise. Evaluation of the clinical signs, laboratory results, and imaging results is generally required for diagnosis of gout in cases where MSU crystals have not been detected. Hyperuricemia is considered a primary cause of arthritis symptoms, and comprehensive guidelines for treatment are available. Therefore, the choice of medication is straightforward, and moderate effectiveness of treatment has been demonstrated. Gout is a chronic disease, requiring lifelong uric acid-lowering medications, thus application of a treatment strategy based on the target blood uric acid concentration is necessary. Consequently, cases of gout will likely be observed more frequently by hip surgeons in clinical scenarios in the future. The objective of this review is to provide an overview of the pathophysiology of gout and subsequently examine recent advances in diagnostic methods and therapeutic agents based on an understanding of its underlying mechanisms. In addition, literature on gout-related issues affecting the hip joint, providing a useful reference for hip surgeons is examined.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jongwon Lee
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Sun Lee
- Advanced Therapy Center, Catholic Kwandong University International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
- Healthcontents, Co., Ltd., Cheongju, Korea
| | - Hyun Hee Lee
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
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Kim HS, Kim H, Kim S, Cha Y, Kim JT, Kim JW, Ha YC, Yoo JI. Precise individual muscle segmentation in whole thigh CT scans for sarcopenia assessment using U-net transformer. Sci Rep 2024; 14:3301. [PMID: 38331977 PMCID: PMC10853213 DOI: 10.1038/s41598-024-53707-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
The study aims to develop a deep learning based automatic segmentation approach using the UNETR(U-net Transformer) architecture to quantify the volume of individual thigh muscles(27 muscles in 5 groups) for Sarcopenia assessment. By automating the segmentation process, this approach improves the efficiency and accuracy of muscle volume calculation, facilitating a comprehensive understanding of muscle composition and its relationship to Sarcopenia. The study utilized a dataset of 72 whole thigh CT scans from hip fracture patients, annotated by two radiologists. The UNETR model was trained to perform precise voxel-level segmentation and various metrics such as dice score, average symmetric surface distance, volume correlation, relative absolute volume difference and Hausdorff distance were employed to evaluate the model's performance. Additionally, the correlation between Sarcopenia and individual thigh muscle volumes was examined. The proposed model demonstrated superior segmentation performance compared to the baseline model, achieving higher dice scores (DC = 0.84) and lower average symmetric surface distances (ASSD = 1.4191 ± 0.91). The volume correlation between Sarcopenia and individual thigh muscles in the male group. Furthermore, the correlation analysis of grouped thigh muscles also showed negative associations with Sarcopenia in the male participants. This thesis presents a deep learning based automatic segmentation approach for quantifying individual thigh muscle volume in sarcopenia assessment. The results highlights the associations between Sarcopenia and specific individual muscles as well as grouped thigh muscle regions, particularly in males. The proposed method improves the efficiency and accuracy of muscle volume calculation, contributing to a comprehensive evaluation of Sarcopenia. This research enhances our understanding of muscle composition and performance, providing valuable insights for effective interventions in Sarcopenia management.
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Affiliation(s)
- Hyeon Su Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea.
| | - Hyunbin Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Shinjune Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, South Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, School of Medicine, Inha University Hospital, Incheon, South Korea.
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Cha Y, Kim JT, Kim JW, Lee JG, Lee SY, Kim HB, Kang YJ, Choy WS, Yoo JI. Analysis of Changes in Sleep Quality and Patterns after Hip Fracture Using Real Evidence of Artificial Intelligence Linked (REAL) Hip Cohort Data. Medicina (Kaunas) 2023; 59:2125. [PMID: 38138229 PMCID: PMC10744893 DOI: 10.3390/medicina59122125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Hip fractures are commonly found in elderly patients, and often result in chronic pain and decreased physical function, as well as worsening of overall health. It is known that early surgical intervention during the acute phase and rehabilitation are important for improving clinical outcomes for these patients. However, the importance of management for improving the quality of life of these patients is becoming more emphasized. Studies on changes in sleep patterns after hip fractures are rare overseas. Therefore, the aim of this study is to investigate the prevalence of sleep disturbance in patients with hip fractures and to analyze the changes in sleep disturbance after surgery by comparing the preoperative and postoperative results. Materials and Methods: During the period from August 2022 to January 2023, patients who underwent surgical treatment for hip fractures and were recruited into the REAL Hip Cohort were selected as research subjects. The sleep survey was conducted using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is composed of 18 questions, each divided into areas of sleep quality, sleep latency, duration, efficiency, disturbance, use of medication, and daytime dysfunction. Each area is scored 0-3 points and the total is 0-21. A score greater than five indicates sleep disorder. The PSQI was surveyed during hospitalization and three months after surgery for post-fracture sleep status. To analyze changes before and after the fracture, paired T-tests and chi-square tests were performed. Results: From August 2022 to January 2023, a total of 40 patients who were recruited into the REAL Hip Cohort responded to the PSQI survey. The average age was 77.4 years and 36 were female. Sleep quality worsened from 0.75 ± 1.0 before surgery to 1.4 ± 1.0 three months after surgery (p = 0.019), and sleep efficiency also worsened from 0.4 ± 0.6 to 1.4 ± 1.0 (p < 0.001). The PSQI increased from an average of 5.2 ± 2.8 before surgery to 8.2 ± 4.2 three months after surgery (p = 0.007), and the number of patients who could be diagnosed with sleep disorders also increased from 12 (40%) to 24 (60%) (p = 0.030). Conclusions: A decline in overall sleep status was observed in patients in a survey on sleep patterns three months after hip fracture. Additional management is needed to improve their sleep patterns.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Republic of Korea
| | - Jin-Gu Lee
- Department of Psychiatry, Daejeon Hospital of Korea Worker’s Compensation and Welfare Service, Daejeon 34384, Republic of Korea
| | - Sang-Yeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Hyun-Bin Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon 22332, Republic of Korea;
| | - Yang Jae Kang
- Division of Life Science Department, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon 22332, Republic of Korea
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Kim SH, Cha Y, Seok SY, Cho JH, Kim BY, Lee HJ, Kim GO. Relationship Between Types of Warming Devices and Surgical Site Infection in Patients Who Underwent Posterior Fusion Surgery Based on National Data. Neurospine 2023; 20:1328-1336. [PMID: 38369362 PMCID: PMC10762424 DOI: 10.14245/ns.2346846.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Perioperative hypothermia can lead to various complications. Although various warming techniques have been used to prevent perioperative hypothermia, the effect of these techniques on surgical site infection (SSI) during posterior fusion surgery is unclear. The effects of warming devices on SSI rates were therefore analyzed using data complied by the Health Insurance and Review Assessment (HIRA) Service in Korea. METHODS This study included 5,406 patients in the HIRA Service database who underwent posterior fusion surgery during the years 2014, 2015, and 2017. Factors related to SSI in these patients, including warming devices, antibiotics, and transfusion, were analyzed. RESULTS The incidence of SSI was higher in patients who underwent forced air warming than in those who did not undergo active warming (odds ratio [OR], 1.73; p = 0.039), especially above 70 years old (OR, 4.11; p = 0.014). By contrast, the incidence of SSI was not significantly higher in patients who underwent device using conduction. Infection rates were higher in patients who received prophylactic antibiotics within 20 minutes before incision, than within 21 to 60 minutes (OR, 2.07; p = 0.001) and who received more blood transfusions (1 pint < volume ≤ 2 pint; OR, 1.75; p = 0.008, > 2 pint; OR, 2.73; p = 0.004). CONCLUSION SSI rates were higher in patients who underwent warming with forced air devices than with devices using conduction, as well as being higher in patients who older age, received blood transfusions and administered antibiotics within 20 minutes before incision. Devices using conduction have more advantages in preventing SSI than forced air warming device. In addition, the reduction of other risk factors for SSI may improve postoperative results.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review & Assessment Service, Wonju, Korea
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Kim SH, Jang SY, Nam K, Cha Y. Analysis of Long-Term Medical Expenses in Vertebral Fracture Patients. Clin Orthop Surg 2023; 15:989-999. [PMID: 38045582 PMCID: PMC10689215 DOI: 10.4055/cios23203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background The objective of this study was to analyze the direct medical expenses of a vertebral fracture cohort (VC) and a matched cohort (MC) over 5 years preceding and following the fracture, analyze the duration of the rise in medical expenses due to the fracture, and examine whether the expenses vary with age group, utilizing a national claims database. Methods Subjects with vertebral fractures and matched subjects were chosen from the National Health Insurance Service Sample cohort (NHIS-Sample) of South Korea. Patients with vertebral fractures were either primarily admitted to acute care hospitals (index admissions) or those who received kyphoplasty or vertebroplasty during the follow-up period (2002-2015). A risk-set matching was performed using 1 : 5 random sampling to simulate a real-world situation. Individual-level direct medical expenses per quarter were calculated for 5 years prior and subsequent to the vertebral fracture. In this analysis using a comparative interrupted time series design, we examined the direct medical expenses of a VC and an MC. Results A total of 3,923 incident vertebral fracture patients and 19,615 matched subjects were included in this study. The mean age was 75.5 ± 7.4 years, and 69.5% were women. The mean difference in medical expenses between the two groups increased steadily before the fracture. The medical expenses of the VC peaked in the first quarter following the fracture. The cost changes were 1.82 times higher for the VC than for the MC (95% confidence interval, 1.62-2.04; p < 0.001) in the first year. Subsequently, there were no differential changes in medical expenses between the two groups (p > 0.05). In the < 70-year subgroup, there were no differential changes in medical expenses between the two groups (p > 0.05). However, in the ≥ 80-year subgroup, the cost changes for the VC were higher than those for the MC up to 5 years after time zero. Conclusions Based on our study results, we suggest that health and medical policies for vertebral fractures should be designed to last up to approximately 1 year after the fracture. Health policies should be differentiated according to age group.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Kyeongdong Nam
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database. Arch Orthop Trauma Surg 2023; 143:7237-7244. [PMID: 37500931 DOI: 10.1007/s00402-023-04917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The aim of our study is to analyze the association of usage and type of warming device with the risk of surgical site infection (SSI) in patients who underwent hip arthroplasty, and to analyze the factors that increase the risk of SSI if the warming device is not used. MATERIALS AND METHODS This retrospective cross-sectional study identified subjects from data of "Evaluation of the Appropriate Use of Prophylactic Antibiotics". Included patients were defined as those who underwent elective unilateral hip hemiarthroplasty or total hip arthroplasty (THA). Patients were classified into no intraoperative warming device, forced air warming devices, and devices using conduction. Multiple logistic regression analysis was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the association between warming devices and SSI. RESULTS A total of 3945 patients met the inclusion criteria. Compared to those who received an intraoperative warming device, the odds of developing SSI were 1.9 times higher in those who did not receive intraoperative warming devices (aOR 1.9; 95% CI 1.1-3.6). The risk of SSI was 2.2 times higher with forced air warming devices compared to devices using conduction but this difference was not statistically significant (aOR 2.2; 95% CI 0.7-6.8). The risk of SSI increased in males (aOR 2.8; 95% CI 1.1-7.2), in patients under 70 years of age (aOR 4.4; 95% CI 1.6-10.4), in patients with a Charlson`s comorbidity index of 2 or higher (aOR 3.3; 95% CI 1.3-8.7), and in patients who underwent THA (aOR 3.8; 95% CI 1.7-8.3) when intraoperative warming devices were not used. CONCLUSIONS The use of intraoperative active warming devices is highly recommended to prevent SSI during elective hip arthroplasty. In particular, male patients younger than 70 years, those with a high CCI, and those undergoing THA are at significantly increased risk of SSI if intraoperative active warming devices are not used. Intraoperative warming device using conduction is likely superior to forced air warming device, but further studies are needed to confirm this.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan Seoro, Seo-Gu, Daejeon, 35233, South Korea.
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
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Kim JW, Yoo JI, Kim JT, Choy WS, Cha Y. Clinical and Radiological Characteristics of Lesser Trochanter Splitting Irreducible Intertrochanteric Fractures. Clin Orthop Surg 2023; 15:560-566. [PMID: 37529199 PMCID: PMC10375813 DOI: 10.4055/cios22325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background The purpose of this study was to investigate the demographic factors and radiological characteristics of lesser trochanter splitting (LTS) irreducible intertrochanteric fractures and to report the clinical results of patients who underwent open reduction and internal fixation using dynamic hip screws (DHS). Methods Inclusion criteria were as follows: AO/Orthopedic Trauma Association type 31A1.2, a fracture line originating from the outside of the greater trochanter that passes through the lesser trochanter, and patients who were followed up for more than 1 year with a confirmed presence or absence of bone union. A total of 13 cases were identified, accounting for 3.1% (13/416 intertrochanteric fractures). Patients were classified according to posterior sagging of the distal shaft fragment relative to the head-neck fragment (posterior sagging group, 6; non-sagging group, 7). Demographic data, comorbidities, injury mechanism, type of anesthesia, operation time, blood loss, tip-apex distance, reduction quality, leg length discrepancy (> 5 mm), long lesser trochanter sign, postoperative complications, and presence of bony union were obtained by reviewing medical records and radiological findings. Results The mean age of the patients was 50.4 ± 10.4 years, and 12 were men. Except for 1 case (slip down), all were induced by high-energy trauma. According to the grade of reduction quality, 5 cases (38.5%) had good reduction quality and 8 cases (61.5%) had acceptable reduction quality. There were no postoperative complications, and bony union was observed in all cases. The long lesser trochanter sign was observed in 5 cases (38.5%) and leg length discrepancy greater than 5 mm was not observed. Compared with the non-sagging group, the posterior sagging group had more head-neck fragments containing more than 1/2 of the lesser trochanter length, longer operation time, and more blood loss (p < 0.05). Compared to the non-sagging group, the posterior sagging group had worse reduction quality and more long lesser trochanter signs (p < 0.05). Conclusions Open reduction and internal fixation using DHS for the LTS irreducible intertrochanteric fractures can achieve good clinical and radiological outcomes. However, in the posterior sagging type, reduction can be more difficult with a longer operation time and higher likelihood of blood loss.
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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12
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Cha Y, Lee S. Endoscopy-assisted latissimus dorsi muscle flap harvesting technique for immediate breast reconstruction. ANN CHIR PLAST ESTH 2023; 68:308-314. [PMID: 36328867 DOI: 10.1016/j.anplas.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the usefulness of endoscopy-assisted latissimus dorsi muscle flap (LDMF) harvesting in immediate breast reconstruction following partial mastectomy. MATERIALS AND METHODS From November 2016 to December 2019, sixteen female breast cancer patients who underwent immediate breast reconstruction following partial mastectomy underwent LDMF harvesting with endoscopic assistance. This surgical technique was carried out with only one subaxillary skin incision without leaving a scar on the back. Patients' demographic characteristics, histopathologic factors, operative data, postoperative complications, and oncologic safety were collected through electronic chart review. RESULTS In sixteen patients, LDMFs were harvested successfully using an endoscopy-assisted technique without conversion to an open technique. The mean age of the patients was 48.0±8.0 years, and the mean body mass index was 24.4±3.9kg/m2. The most common histologic subtype was invasive ductal carcinoma, with a mean tumor size of 3.2±2.3cm. In terms of LDMF harvesting time, it took 168.4±44.0minutes. The most common postoperative complication, donor site seroma (75%), was managed non-surgically during the outpatient visit. In terms of cosmetic aspects, we've seen a high level of patient satisfaction, especially with scarring. CONCLUSIONS Endoscopy-assisted LDMF harvesting technique is safe and useful for breast reconstruction after partial mastectomy. Compared to the conventional open technique, this method does not leave a long scar on the donor site. As a result, it leads to better cosmetic outcomes and improves patient satisfaction.
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Affiliation(s)
- Y Cha
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, 49241 Busan, Republic of Korea
| | - S Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, 49241 Busan, Republic of Korea.
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13
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Cha Y, Seo SH, Kim JT, Kim JW, Lee SY, Yoo JI. Osteoporosis Feature Selection and Risk Prediction Model by Machine Learning Using a Cross-Sectional Database. J Bone Metab 2023; 30:263-273. [PMID: 37718904 PMCID: PMC10509024 DOI: 10.11005/jbm.2023.30.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The purpose of this study was to verify the accuracy and validity of using machine learning (ML) to select risk factors, to discriminate differences in feature selection by ML between men and women, and to develop predictive models for patients with osteoporosis in a big database. METHODS The data on 968 observed features from a total of 3,484 the Korea National Health and Nutrition Examination Survey participants were collected. To find preliminary features that were well-related to osteoporosis, logistic regression, random forest, gradient boosting, adaptive boosting, and support vector machine were used. RESULTS In osteoporosis feature selection by 5 ML models in this study, the most selected variables as risk factors in men and women were body mass index, monthly alcohol consumption, and dietary surveys. However, differences between men and women in osteoporosis feature selection by ML models were age, smoking, and blood glucose level. The receiver operating characteristic (ROC) analysis revealed that the area under the ROC curve for each ML model was not significantly different for either gender. CONCLUSIONS ML performed a feature selection of osteoporosis, considering hidden differences between men and women. The present study considers the preprocessing of input data and the feature selection process as well as the ML technique to be important factors for the accuracy of the osteoporosis prediction model.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Sung Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju,
Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon,
Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul,
Korea
| | - Sang-Yeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju,
Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon,
Korea
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14
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Cha Y, Kim JT, Kim JW, Seo SH, Lee SY, Yoo JI. Effect of Artificial Intelligence or Machine Learning on Prediction of Hip Fracture Risk: Systematic Review. J Bone Metab 2023; 30:245-252. [PMID: 37718902 PMCID: PMC10509025 DOI: 10.11005/jbm.2023.30.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Dual energy X-ray absorptiometry (DXA) is a preferred modality for screening or diagnosis of osteoporosis and can predict the risk of hip fracture. However, the DXA test is difficult to implement easily in some developing countries, and fractures have been observed before patients underwent DXA. The purpose of this systematic review is to search for studies that predict the risk of hip fracture using artificial intelligence (AI) or machine learning, organize the results of each study, and analyze the usefulness of this technology. METHODS The PubMed, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched including "hip fractures" AND "artificial intelligence". RESULTS A total of 7 studies are included in this study. The total number of subjects included in the 7 studies was 330,099. There were 3 studies that included only women, and 4 studies included both men and women. One study conducted AI training after 1:1 matching between fractured and non-fractured patients. The area under the curve of AI prediction model for hip fracture risk was 0.39 to 0.96. The accuracy of AI prediction model for hip fracture risk was 70.26% to 90%. CONCLUSIONS We believe that predicting the risk of hip fracture by the AI model will help select patients with high fracture risk among osteoporosis patients. However, to apply the AI model to the prediction of hip fracture risk in clinical situations, it is necessary to identify the characteristics of the dataset and AI model and use it after performing appropriate validation.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon,
Korea
| | - Jin-Woo Kim
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul,
Korea
| | - Sung Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju,
Korea
| | - Sang-Yeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju,
Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon,
Korea
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15
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Kim S, Park S, Lee S, Seo SH, Kim HS, Cha Y, Kim JT, Kim JW, Ha YC, Yoo JI. Assessing physical abilities of sarcopenia patients using gait analysis and smart insole for development of digital biomarker. Sci Rep 2023; 13:10602. [PMID: 37391464 PMCID: PMC10313812 DOI: 10.1038/s41598-023-37794-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023] Open
Abstract
The aim of this study is to compare variable importance across multiple measurement tools, and to use smart insole and artificial intelligence (AI) gait analysis to create variables that can evaluate the physical abilities of sarcopenia patients. By analyzing and comparing sarcopenia patients with non sarcopenia patients, this study aims to develop predictive and classification models for sarcopenia and discover digital biomarkers. The researchers used smart insole equipment to collect plantar pressure data from 83 patients, and a smart phone to collect video data for pose estimation. A Mann-Whitney U was conducted to compare the sarcopenia group of 23 patients and the control group of 60 patients. Smart insole and pose estimation were used to compare the physical abilities of sarcopenia patients with a control group. Analysis of joint point variables showed significant differences in 12 out of 15 variables, but not in knee mean, ankle range, and hip range. These findings suggest that digital biomarkers can be used to differentiate sarcopenia patients from the normal population with improved accuracy. This study compared musculoskeletal disorder patients to sarcopenia patients using smart insole and pose estimation. Multiple measurement methods are important for accurate sarcopenia diagnosis and digital technology has potential for improving diagnosis and treatment.
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Affiliation(s)
- Shinjune Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - Seongjin Park
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sangyeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sung Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyeon Su Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, Republic of Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Bumin Medical Center, Seoul, Republic of Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea.
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16
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Cha Y, Chung JY, Jung CH, Kim JW, Lee J, Yoo JI, Kim JT, Jeon Y. Pre-sliding of femoral neck system improves fixation stability in pauwels type III femoral neck fracture: a finite element analysis. BMC Musculoskelet Disord 2023; 24:506. [PMID: 37344858 PMCID: PMC10286416 DOI: 10.1186/s12891-023-06631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Femoral neck fractures are a common injury in older adults and their management presents a significant challenge for orthopedic surgeons. The Femoral Neck System (FNS) was recently introduced for the fixation of femur neck fractures. Although neck shortening was reduced with the FNS, the complication rates were not reduced. Thus, improvements to enhance fixation stability should be made for the FNS. We hypothesized that (1) the pre-sliding technique and (2) the use of longer anti-rotation screw would increase fracture stability. This study aimed to determine the change in fracture stability using the pre-sliding technique and long anti-rotation screw in the FNS for fixation of Pauwels type III femoral neck fractures. METHODS Finite element models of Pauwels type III femoral neck fracture fixed with pre-sliding FNS and 5-mm longer anti-rotation screw were established. The models were subjected to normal walking load. The material properties of the elements belonging to the bone were mapped by assigning the formulation with the computed tomography Hounsfield unit. RESULTS Pauwels type III femoral neck fractures fixed with pre-slided FNS showed better fracture stability, decreasing fracture gap and sliding by 14% and 12%, respectively, under normal walking load. No element of cortical bone in any of the models had an absolute value of principal strain that exceeded 1%. The peak von Mises stress (VMS) of the implants ranged from 260 to 289 MPa, and the highest peak VMS value was 50% lower than the yield strength of the titanium alloy (800 MPa). The longer anti-rotation screw did not affect fracture stability. CONCLUSIONS The pre-sliding technique using the FNS showed higher fracture stability than the standard fixation technique for a Pauwels type III femoral neck fracture. The longer anti-rotation screw did not contribute significantly to fixation stability. As this finite element analysis considered the inhomogeneous mechanical property of the bone, it offered equivalent mechanical conditions to investigate the components of interest.
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Grants
- HI22C0494 the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- HI22C0494 the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- HI22C0494 the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- HI20C2140 the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- 2022R1G1A1003299 the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)
- the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji university hospital, Daejeon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, 16499, Suwon, Suwon-si, Gyeonggi-do, Korea
| | - Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jeyoon Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, 16499, Suwon, Suwon-si, Gyeonggi-do, Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, 16499, Suwon, Suwon-si, Gyeonggi-do, Korea.
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
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17
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Jung CH, Cha Y, Chung JY, Park CH, Kim TY, Yoo JI, Kim JT, Jeon Y. Trajectory of bolt and length of plate in femoral neck system determine the stability of femur neck fracture and risk of subsequent subtrochanteric fracture : a finite element analysis. BMC Musculoskelet Disord 2023; 24:465. [PMID: 37280558 DOI: 10.1186/s12891-023-06579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study aimed to analyze the differences in the stability of fractures, stress distribution around the distal-most screw according to the length of the plate and the trajectory of the bolt in Pauwels type III femoral neck fracture using the femoral neck system (FNS). METHODS Finite element models of Pauwels type III femoral neck fractures were established with surgical variations in the trajectory of the bolt (central, inferior, valgus, and varus) and length of the lateral plate (1- and 2-hole plate). The models were subsequently subjected to normal walking and stair-climbing loads. RESULTS The screw-holding cortical bone in subtrochanter in the model with a 2-hole plate and the bolt in the inferior trajectory and the models with 1-hole or 2-hole plate and the bolt in valgus trajectory had shown greater maximum principal strain than the models with central or varus trajectories. The gap and sliding distance on the fracture surface were larger with inferior or varus trajectories of the bolt and smaller with the valgus trajectory of the bolt under both loads, compared to those of the central trajectory. CONCLUSION For the fixation of Pauwels type III femoral neck fracture, the trajectory of the FNS bolt and the length of the plate affect the mechanical stability of the fracture and the strain of cortical bone around the distal-most screw. The surgical target should stay on the central trajectory of the bolt and the 2-hole plate's mechanical benefits did not exceed the risk.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji university hospital, Daejeon, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, New Daesung Hospital, Bucheon, Korea
| | - Tae Young Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
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Jang SY, Cha Y, Kim Y, Kim KJ, Kim H, Choy W. Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort. J Korean Med Sci 2023; 38:e137. [PMID: 37158773 PMCID: PMC10166703 DOI: 10.3346/jkms.2023.38.e137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. METHODS We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. RESULTS The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, -5%; 95% CI, -13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, -8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, -2%; 95% CI, -3 to -1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). CONCLUSIONS In 2020, the incidence rate of hip fracture did not significantly decrease, and in-hospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hayong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Ki H, Gu J, Cha Y, Lee KW, Ihee H. Projection to extract the perpendicular component (PEPC) method for extracting kinetics from time-resolved data. Struct Dyn 2023; 10:034103. [PMID: 37388296 PMCID: PMC10306411 DOI: 10.1063/4.0000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
Time-resolved x-ray liquidography (TRXL) is a potent method for investigating the structural dynamics of chemical and biological reactions in the liquid phase. It has enabled the extraction of detailed structural aspects of various dynamic processes, the molecular structures of intermediates, and kinetics of reactions across a wide range of systems, from small molecules to proteins and nanoparticles. Proper data analysis is key to extracting the information of the kinetics and structural dynamics of the studied system encrypted in the TRXL data. In typical TRXL data, the signals from solute scattering, solvent scattering, and solute-solvent cross scattering are mixed in the q-space, and the solute kinetics and solvent hydrodynamics are mixed in the time domain, thus complicating the data analysis. Various methods developed so far generally require prior knowledge of the molecular structures of candidate species involved in the reaction. Because such information is often unavailable, a typical data analysis often involves tedious trial and error. To remedy this situation, we have developed a method named projection to extract the perpendicular component (PEPC), capable of removing the contribution of solvent kinetics from TRXL data. The resulting data then contain only the solute kinetics, and, thus, the solute kinetics can be easily determined. Once the solute kinetics is determined, the subsequent data analysis to extract the structural information can be performed with drastically improved convenience. The application of the PEPC method is demonstrated with TRXL data from the photochemistry of two molecular systems: [Au(CN)2-]3 in water and CHI3 in cyclohexane.
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Affiliation(s)
| | | | | | | | - H. Ihee
- Author to whom correspondence should be addressed:
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20
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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. How Does Medical Policy on the Use of Prophylactic Antibiotics Affect Medical Costs, Length of Hospital Stay, and Antibiotic Use in Orthopedics? Yonsei Med J 2023; 64:213-220. [PMID: 36825348 PMCID: PMC9971434 DOI: 10.3349/ymj.2022.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE The purpose of this study was to compare patients who had undergone spine surgery (SS) and hip arthroplasty surgery (HAS) and to analyze how medical policies drawn from "The Evaluation of the Appropriate Use of Prophylactic Antibiotics" have affected length of hospital stay (LOS), direct medical costs (DMC), and the duration of antibiotics use in Korea. MATERIALS AND METHODS This retrospective nationwide study identified subjects from the Korean National Health Insurance Review and Assessment Service database from January, 2011 to December, 2018. Evaluation of HAS (control group) was implemented in 2007, and that for SS (case group) was conducted for the first time in 2014 (intervention time). In our comparative interrupted time series analysis, we compared DMC, LOS, and use of antibiotics between both groups. RESULTS 177468 patients who underwent SS and 89372 patients who underwent HAS were included in the study. In 2016, DMC increased for HAS, compared to SS, by 1.03 times (p=0.041). However, cost changes during other observational periods for SS were not higher than those for HAS (p>0.05). SS incurred a reduced LOS of 3% in the first 2 years (p<0.05). Thereafter, LOS changes in SS were not smaller than those in HAS. A decrease in the usage of total antibiotics and broad spectrum antibiotics was observed for 5 years. CONCLUSION This medical policy was effective in terms of reducing usage and duration of antibiotics use, especially in the first 2 years after the implementation of the policy.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review & Assessment Service, Wonju, Korea
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21
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Oh CR, Kim JE, Lee JS, Kim SY, Kim TW, Choi J, Kim J, Park IJ, Lim SB, Park JH, Kim JH, Choi MK, Cha Y, Baek JY, Beom SH, Hong YS. Preoperative Chemoradiotherapy With Capecitabine With or Without Temozolomide in Patients With Locally Advanced Rectal Cancer: A Prospective, Randomised Phase II Study Stratified by O 6-Methylguanine DNA Methyltransferase Status: KCSG-CO17-02. Clin Oncol (R Coll Radiol) 2023; 35:e143-e152. [PMID: 36376167 DOI: 10.1016/j.clon.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/03/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
AIMS To evaluate the clinical efficacy of adding temozolomide (TMZ) to preoperative capecitabine (CAP)-based chemoradiotherapy in patients with locally advanced rectal cancer (LARC) and validate O6-methylguanine DNA methyltransferase (MGMT) methylation status as a predictive marker for TMZ combined regimens. MATERIALS AND METHODS LARC patients with clinical stage II (cT3-4N0) or III (cTanyN+) disease were enrolled. They were stratified into unmethylated MGMT (uMGMT) and methylated MGMT (mMGMT) groups by methylation-specific polymerase chain reaction before randomisation and were then randomly assigned (1:1) to one of four treatment arms: uMGMT/CAP (arm A), uMGMT/TMZ + CAP (arm B), mMGMT/CAP (arm C) and mMGMT/TMZ + CAP (arm D). The primary end point was the pathological complete response (pCR) rate. RESULTS Between November 2017 and July 2020, 64 patients were randomised. Slow accrual caused early study termination. After excluding four ineligible patients, 60 were included in the full analysis set. The pCR rate was 15.0% (9/60), 0%, 14.3%, 18.8% and 26.7% for the entire cohort, arms A, B, C and D, respectively (P = 0.0498 between arms A and D). The pCR rate was 9.7% in the CAP group (arms A + C), 20.7% in the TMZ + CAP group (arms B + D), 6.9% in the uMGMT group (arms A + B) and 22.6% in the mMGMT group (arms C + D). Grade 1-2 nausea or vomiting was significantly more frequent in the TMZ + CAP treatment groups (arms B + D) than in the CAP treatment groups (arms A + C, P < 0.001) with no difference in grade 3 adverse events. There were no grade 4 or 5 adverse events. CONCLUSION The addition of TMZ to CAP-based chemoradiotherapy tended to improve pCR rates, particularly in those with mMGMT LARC. MGMT status may warrant further investigation as a predictive biomarker for chemotherapeutic agents and radiotherapy.
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Affiliation(s)
- C R Oh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - J E Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J S Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Y Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Choi
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - I J Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-B Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M K Choi
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Y Cha
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - J Y Baek
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - S-H Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y S Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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22
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Lim JY, Kim YY, Kim JW, Hong S, Min K, Beom J, Yoon BH, Lee SY, Kong SH, Yoo JI, Park MS, Nho JH, Ko S, Joo MW, Kim DH, Park CH, Kim TY, Sohn S, Park SY, Hong AR, Kwon YJ, Park SB, Lee YK, Moon NH, Kim BR, Park Y, Cha Y, Ha YC. Fracture Liaison Service in Korea: 2022 Position Statement of the Korean Society for Bone and Mineral Research. J Bone Metab 2023; 30:31-36. [PMID: 36950838 PMCID: PMC10036182 DOI: 10.11005/jbm.2023.30.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 03/24/2023] Open
Abstract
Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.
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Affiliation(s)
- Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Yul Kim
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | | | - Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sangbong Ko
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Min Wook Joo
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Bucheon Daesung Medical Center, Bucheon, Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seil Sohn
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joo Kwon
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hopital, Seoul, Korea
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23
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Cha Y, Kim JT, Park CH, Kim JW, Lee SY, Yoo JI. Artificial intelligence and machine learning on diagnosis and classification of hip fracture: systematic review. J Orthop Surg Res 2022; 17:520. [PMID: 36456982 PMCID: PMC9714164 DOI: 10.1186/s13018-022-03408-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In the emergency room, clinicians spend a lot of time and are exposed to mental stress. In addition, fracture classification is important for determining the surgical method and restoring the patient's mobility. Recently, with the help of computers using artificial intelligence (AI) or machine learning (ML), diagnosis and classification of hip fractures can be performed easily and quickly. The purpose of this systematic review is to search for studies that diagnose and classify for hip fracture using AI or ML, organize the results of each study, analyze the usefulness of this technology and its future use value. METHODS PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to June 2022 with English language restriction. The following search terms were used [All Fields] AND (", "[MeSH Terms] OR (""[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fracture"[All Fields]). The following information was extracted from the included articles: authors, publication year, study period, type of image, type of fracture, number of patient or used images, fracture classification, reference diagnosis of fracture diagnosis and classification, and augments of each studies. In addition, AI name, CNN architecture type, ROI or important region labeling, data input proportion in training/validation/test, and diagnosis accuracy/AUC, classification accuracy/AUC of each studies were also extracted. RESULTS In 14 finally included studies, the accuracy of diagnosis for hip fracture by AI was 79.3-98%, and the accuracy of fracture diagnosis in AI aided humans was 90.5-97.1. The accuracy of human fracture diagnosis was 77.5-93.5. AUC of fracture diagnosis by AI was 0.905-0.99. The accuracy of fracture classification by AI was 86-98.5 and AUC was 0.873-1.0. The forest plot represented that the mean AI diagnosis accuracy was 0.92, the mean AI diagnosis AUC was 0.969, the mean AI classification accuracy was 0.914, and the mean AI classification AUC was 0.933. Among the included studies, the architecture based on the GoogLeNet architectural model or the DenseNet architectural model was the most common with three each. Among the data input proportions, the study with the lowest training rate was 57%, and the study with the highest training rate was 95%. In 14 studies, 5 studies used Grad-CAM for highlight important regions. CONCLUSION We expected that our study may be helpful in making judgments about the use of AI in the diagnosis and classification of hip fractures. It is clear that AI is a tool that can help medical staff reduce the time and effort required for hip fracture diagnosis with high accuracy. Further studies are needed to determine what effect this causes in actual clinical situations.
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Affiliation(s)
- Yonghan Cha
- grid.411061.30000 0004 0647 205XDepartment of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jung-Taek Kim
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan-Ho Park
- Department of Orthopedic Surgery, Yonsei 100 Percent Hospital, Incheon, Korea
| | - Jin-Woo Kim
- grid.255588.70000 0004 1798 4296Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sang Yeob Lee
- grid.411899.c0000 0004 0624 2502Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jun-Il Yoo
- grid.411899.c0000 0004 0624 2502Department of Orthopaedic Surgery, Gyeongsang National University Hospital, 90 Chilamdong, Jinju, Gyeongnamdo 660-702 Republic of Korea
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24
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Jang SY, Cha Y, Park NK, Kim KJ, Choy WS. Effect Modification on Death by Age and Sex in Elderly Hip Fracture. J Bone Metab 2022; 29:235-243. [PMID: 36529866 PMCID: PMC9760768 DOI: 10.11005/jbm.2022.29.4.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study compared the effects of hip fractures on mortality according to sex and age in a nationwide cohort of elderly patients with hip fractures and controls. METHODS Patients with hip fractures and matched controls were selected from the National Health Insurance Service-Senior cohort. Time-dependent propensity score matching was estimated from a Cox proportional hazards model with January 1, 2005, as the baseline and hip fracture as an event. Patients were matched by age and sex to participants at risk of developing a hip fracture at time zero. The effect size is presented as hazard ratio (HR) using a Cox proportional hazards model with a robust variance estimator that accounts for clustering within the matched pairs. RESULTS Altogether, 14,283 patients with incident hip fractures and 28,566 matched controls were identified. The HR of male sex in hip fractures was 1.31 (95% confidence interval [CI], 1.22-1.40; Pinteraction<0.01). Moreover, the HR of age group in hip fractures was 0.73 (95% CI, 0.66-0.80; Pinteraction<0.01) between the 65 to 74 and 75 to 84 years groups, 0.76 (95% CI, 0.71-0.81; Pinteraction<0.01) between the 75 to 84 and ≥85 years groups, and 0.55 (95% CI, 0.50-0.61; Pinteraction<0.01) between the 65 to 74 and ≥85 years groups. CONCLUSIONS Male sex increases the risk of death in elderly patients with hip fractures versus matched controls, but the increased risk of death with age in hip fractures was decreased compared to that in matched controls.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul,
Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Na-Kyum Park
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
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25
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Cha Y, Kim HE, Jeon SB, Park SW, Lee SH, Lee CJ. PCSK9 modulates the Wnt/beta-catenin signaling pathway in myocardial ischemia/reperfusion injury. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protein that affects cholesterol homeostasis. Recent research has found that PCSK9 has various effects on the heart that are unrelated to LDL cholesterol regulation. The Wnt/β-catenin signaling pathway plays a crucial role during heart development, and it is re-activated in response to cardiac injury. Low-density lipoprotein receptor-related proteins 5 (LRP5) act as co-receptors of Wnt ligands and are indispensable for Wnt/β-catenin signal transduction. However, it is not fully elucidated whether other members of the LDLR-superfamily may be targets of PCSK9.
Purpose
This study aimed to determine if LRP5 is a PCSK9 target, study the association between PCSK9 and Wnt/β-catenin signaling, and elucidate its effect on myocardial infarction in patients with ischemic cardiomyopathy.
Methods
The expression of Lrp5, phospho-β-catenin, total β-catenin was evaluated by western blot analysis, and the effects of overexpressed PCSK9 were tested under normoxia, hypoxia, or hypoxia/re-oxygenation (H/R) in mouse cardiomyocytes (HL-1). The transcriptional activity of β-catenin was assessed using the TOP-Flash/FOP-Flash luciferase reporter assay. In addition, the impact on various downstream targets of the Wnt/β-catenin signaling pathway was assessed using a quantitative real-time polymerase chain reaction. To examine whether PCSK9 regulates injury of cardiomyocytes in vivo, we subjected transgenic mice with cardiac-specific overexpression of PCSK9 (PCSK9 TG) and wild-type (WT) mice to either sham surgery or ischemia/reperfusion (I/R) surgery.
Results
Under hypoxic conditions, the Wnt/β-catenin signaling pathway-related genes were downregulated in HL-1 cells, as evidenced by lower Lrp5 and active phospho-β-catenin expression levels (0.5-fold, n=3, p<0.01). After H/R, the Wnt/β-catenin-related genes were recovered (1.5-fold, p<0.01) in the control group but not in the PCSK9 overexpressed group. In the luciferase reporter assay results, PCSK9 overexpression inhibited the recovery of β-catenin transcriptional activity after H/R, in contrast to the control group. Furthermore, mRNA levels of Axin2, Cyclin D1, which are the Wnt/β-catenin signaling downstream pathway targets, were down-regulated under hypoxia and recovered after H/R but did not recover in PCSK9 overexpressed cells. In the mouse I/R model, the overall protein levels of the Wnt/β-catenin signaling-related genes were down-regulated in PCSK9 TG mice compared to WT mice after I/R injury.
Conclusions
These results indicated that the regulation of PCSK9 is closely associated with the Wnt/β-catenin signaling pathway which may play a crucial role in damaged cardiomyocytes. It suggests that the regulation of PCSK9 could be a therapeutic target in patients with ischemic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Cha
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - H E Kim
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - S B Jeon
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - S W Park
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Brain Korea 21 , Seoul , Korea (Republic of)
| | - S H Lee
- Yonsei University College of Medicine, Department of Biochemistry and Molecular Biology , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Division of Cardiology , Seoul , Korea (Republic of)
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26
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Lee JM, Park CH, Yoo JI, Kim JT, Cha Y. Atypical periprosthetic femoral fracture with stem breakage: a case report. Osteoporos Int 2022; 33:2043-2047. [PMID: 35688896 DOI: 10.1007/s00198-022-06463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
Although the American Society for Bone and Mineral Research definition of atypical femoral fracture excludes periprosthetic fractures, fractures around the prosthesis with clinical features of atypical femoral fractures have been reported in the literature. All fractures reported thus far have been distal to the prosthetic segment; however, we encountered a case of a stress fracture in the middle of the femoral component segment. An 86-year-old woman with a history of bisphosphonate osteoporosis treatment and revisional total hip arthroplasty visited our outpatient clinic complaining of pain in the left thigh and groin. We diagnosed an incomplete atypical femoral fracture around the hip prosthesis; medical treatment was implemented. Two months later, the patient visited the emergency department with a complete subtrochanteric fracture with stem breakage. Without revision of the broken stem, two plates were applied after reduction. In this case, we recognized the possibility of a stress fracture but overlooked the possibility of stem breakage in an atypical femoral fracture. Even if it is not evident on the radiograph before complete fracture, clinicians should be alert to the signs of stress fracture in the middle of the femoral component segment, as they may be clues to atypical periprosthetic femoral fracture with stem failure. Isolated medical treatment plans are not recommended for incomplete subtrochanteric atypical periprosthetic femoral fracture. Instead, concomitant prophylactic plate fixation is recommended.
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Affiliation(s)
- J M Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea
| | - C H Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - J-I Yoo
- Department of Orthopedics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - J-T Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea.
| | - Y Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan-Seoro, Seo-gu, Daejeon, 302-799, South Korea.
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27
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Yoo JI, Jang SY, Cha Y, Gwak JH, Kim JT, Park CH, Choy WS. Association between antidepressants, benzodiazepine and all-cause mortality in elderly hip fracture: A Korean nationwide cohort study. J Orthop Sci 2022; 27:1089-1095. [PMID: 34391618 DOI: 10.1016/j.jos.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the association between the preoperative and postoperative use of antidepressant and benzodiazepine and all-cause mortality in elderly hip fracture patients. METHODS Patients who underwent surgical treatment for hip fracture over 65 years old were classified into Past-user, Current-user, and Non-users for each period according to use history for antidepressants or benzodiazepines. And, for the subgroup analysis, patients were classified by presence of past history for psychiatric medication. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of antidepressants and benzodiazepines on all-cause mortality. RESULTS A total of 15,576 patients were included in this study. Past users of antidepressants and benzodiazepines were 5699 (36.59%) patients and 11,319 (72.67%) patients, respectively. Current users of antidepressants and benzodiazepines were 2888 (18.54%) patients and 6287 (40.36%) patients, respectively. There were no statistically significant differences in the adjusted hazard for death compared to the non-users for both the past and the current users (p > 0.05). In the subgroup analysis, there were 12,502 once-users and 3074 never-users according to psychiatric medication. Current uses of antidepressants and benzodiazepine in the once-user did not increase adjusted hazard for death compared to the non-users (p>0.05). However, current uses of antidepressants by never-users increased the adjusted hazard for death compared to the non-user (adjusted hazard ratio, 1.31; 95% CI, 1.08-1.59; p = 0.007). CONCLUSIONS No association was observed between the uses of antidepressants and benzodiazepines after hip fracture and mortality risk in elderly patients who received psychiatric medication before hip fracture. However, the use of these medications was associated with increased all-cause mortality risk in patients who had no history of psychiatric medication before hip fracture. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
| | - Joon-Hyeok Gwak
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University Medical Center, Suwon, South Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Yoo JI, Cha Y, Kim JT, Park CH, Choy W, Koo KH. Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions. Clin Orthop Surg 2022; 14:155-161. [PMID: 35685973 PMCID: PMC9152889 DOI: 10.4055/cios21156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/28/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Yoo JI, Ha YC, Cha Y. Nutrition and Exercise Treatment of Sarcopenia in Hip Fracture Patients: Systematic Review. J Bone Metab 2022; 29:63-73. [PMID: 35718923 PMCID: PMC9208903 DOI: 10.11005/jbm.2022.29.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to investigate nutritional or rehabilitation intervention protocols for hip fracture patients with sarcopenia and to analyze the effect of these protocols through a systematic review of studies that reported clinical results. Methods Studies were selected based on the following criteria: (1) study design: randomized controlled trials or non-randomized comparative studies; (2) study population: patients with hip fracture; (3) intervention: nutritional or rehabilitation; and (4) reporting the clinical outcomes and definition of sarcopenia. Results Of the 247 references initially identified from the selected databases, 5 randomized controlled studies and 2 comparative studies were selected for further investigation. The total number of patients was 497. We found 2 specific rehabilitation interventions, one medication intervention using erythropoietin, and 4 nutritional interventions using amino-acid or protein. Among the studies included in this systematic review, 2 studies did not find a clear statistical difference in assessment tools compared to controls after intervention. On the other hand, the rest of the studies positively interpreted the results for intervention. The most frequently used assessment tool for intervention was handgrip strength. Conclusions Although mainstream methods of intervention for sarcopenia include nutritional, exercise, and drug interventions, the validity of these interventions in elderly hip fractures has not been clearly proven. In addition, as most studies only reported short-term results, there is no consensus on the optimal long-term treatment.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongang National University Hospital, Gyeongsang National University, Jinju, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Jang SY, Lee JW, Kim KJ, Kim HY, Choy WS, Cha Y. Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study. Clin Orthop Relat Res 2022; 480:891-902. [PMID: 34807010 PMCID: PMC9007206 DOI: 10.1097/corr.0000000000002051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies on medical costs in patients with hip fractures have focused on medical costs incurred for a short period after the injury. However, patients often had comorbidities before their hip fractures that would have affected medical costs even had they not sustained a fracture. Consequently, these studies may have overestimated the costs associated with hip fractures and did not characterize the duration of increased medical costs adequately. Without knowing this crucial information, it is difficult to craft thoughtful health policy to support these patients' needs. QUESTIONS/PURPOSES (1) To compare the direct medical costs for 5 years before fracture and up to 5 years after injury in a group of patients who underwent hip fracture surgery with a matched group of patients who did not experience a hip fracture, (2) to analyze the duration over which the increased direct medical costs associated with a hip fracture continues, and (3) to analyze whether there is a difference in direct medical costs according to age group using a nationwide claims database in South Korea. METHODS The National Health Insurance Service Sample cohort in South Korea consisted of 1 million patients who were selected using a systematic, stratified, random sampling method from 48,222,537 individuals on December 31, 2006. Under a compulsory social insurance system established by the National Health Insurance Act, all patients were followed until 2015. Patients with hip fractures and matched controls were selected from the National Health Insurance Service sample of South Korea. Patients with hip fractures were defined as those who were hospitalized with a diagnosis of femoral neck fracture or intertrochanteric fracture and who underwent surgical treatment. We excluded patients with hip fractures before January 1, 2007 to ensure a minimum 5-year period that was free of hip fractures. Patients with hip fractures were matched with patients of the same age and gender at the date of admission to an acute care hospital for surgery (time zero). If patients with hip fractures died during the follow-up period, we performed matching among patients whose difference from the time of death was within 1 month. This method of risk-set matching was repeated sequentially for the next patient until the last patient with a hip fracture was matched. We then sequentially performed 1:5 random sampling for each risk set. A total of 3583 patients in the hip fracture cohort (patients with hip fractures) and 17,915 patients in the matched cohort (those without hip fractures) were included in this study. The mean age was 76 ± 9 years, and 70% were women in both groups. Based on the Charlson comorbidity index score, medication, and medical history, the patients with hip fractures had more comorbidities. Person-level direct medical costs per quarter were calculated for 5 years before time zero and up to 5 years after time zero. Direct medical costs were defined as the sum of that insurer's payments (that is, the National Health Insurance Service's payments), and that patient's copayments, excluding uncovered payments. We compared direct medical costs between patients with hip fractures and the patients in the matched cohort using a comparative interrupted time series analysis. The difference-in-difference estimate is the ratio of the differences in direct medical costs before and after time zero in the hip fracture cohort to the difference in direct medical costs before and after time zero in the matched cohort; the difference in difference estimates were calculated each year after injury. To identify changes in direct medical cost trends in patients with hip fractures and all subgroups, joinpoint regression was estimated using statistical software. RESULTS The direct medical costs for the patients with hip fractures were higher than those for patients in the matched cohort at every year during the observation period. The difference in direct medical costs between the groups before time zero has increased every year. The direct medical costs in patients with hip fractures was the highest in the first quarter after time zero. Considering the differential changes in direct medical costs before and after time zero, hip fractures incurred additional direct medical costs of USD 2514 (95% CI 2423 to 2606; p < 0.01) per patient and USD 264 (95% CI 166 to 361; p < 0.01) per patient in the first and second years, respectively. The increase in direct medical costs attributable to hip fracture was observed for 1.5 to 2 years (difference-in-difference estimate at 1 year 3.0 [95% CI 2.8 to 3.2]; p < 0.01) (difference-in-difference estimate at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 year). In the subgroups of patients younger than 65, patients between 65 and 85, and patients older than 85 years of age, the increase in direct medical costs attributable to hip fracture continued up to 1 year (difference-in-difference estimate ratio at 1 year 2.7 [95% CI 2.1 to 3.4]; p < 0.01; joinpoint 1 year), 1.5 to 2 years (difference-in-difference estimate ratio at 1 year 2.8 [95% CI 2.6 to 3.1]; p < 0.01; difference-in-difference estimate ratio at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 years), and 39 months to 5 years (difference-in-difference estimate ratio at 1 year 5.2 [95% CI 4.4 to 6.2]; p < 0.01; difference-in-difference estimate ratio at 5 years 2.1 [95% CI 1.4 to 3.1]; p < 0.01; joinpoint 39 months) from time zero, respectively. CONCLUSION The direct medical costs in patients with hip fractures were higher than those in the matched cohort every year during the 5 years before and after hip fracture. The increase in direct medical costs because of hip fractures was maintained for 1.5 to 2 years and was greater in older patients. Based on this, we suggest that health policies should focus on patients' financial and social needs, with particular emphasis on the first 2 years after hip fracture with stratification based on patients' ages. LEVEL OF EVIDENCE Level II, economic analysis.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jang-Won Lee
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Yoo JI, Kim JT, Park CH, Cha Y. Diagnosis and Management of Sarcopenia after Hip Fracture Surgery: Current Concept Review. Hip Pelvis 2022; 34:1-9. [PMID: 35355632 PMCID: PMC8931950 DOI: 10.5371/hp.2022.34.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
To date, family medicine and internal medicine fields have been responsible for defining, researching, and development of treatments for sarcopenia, focusing mainly on diabetes and metabolic diseases. Therefore, application of current guidelines for diagnosis of sarcopenia which differ according to continent to patients with hip fractures in the orthopedic field is difficult. The purpose of this review was to understand the recent consensus on the definition and diagnosis of sarcopenia and to highlight the importance of research and future research opportunities on the management of sarcopenia in patients with hip fractures by orthopedic surgeons. The global prevalence of sarcopenia in patients with hip fractures is statistically significant. Despite establishment of various therapeutic and diagnostic criteria for osteoporosis in the clinical field, there are no clear, useful diagnostic criteria for sarcopenia in the clinical field. In particular, few studies on the evaluation and treatment of sarcopenia in patients with hip fractures have been reported. In addition, the quality of life of postoperative patients with hip fractures could be significantly improved by development of precise assessment for muscle regeneration and rehabilitation in the operating room.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Yoo JI, Cha Y, Lee YK, Ha YC, Koo KH. Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e41. [PMID: 35166078 PMCID: PMC8845099 DOI: 10.3346/jkms.2022.37.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems. METHODS We conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results. RESULTS Among the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02-0.09; Z = -2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76-1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59-1.40; Z = -0.44, P = 0.663). CONCLUSIONS We did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty. TRIAL REGISTRATION PROSPERO Identifier: CRD42021231240.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Jung CH, Cha Y, Yoon HS, Park CH, Yoo JI, Kim JT, Jeon Y. Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture : a finite element analysis. Bone Joint Res 2022; 11:102-111. [PMID: 35168366 PMCID: PMC8882323 DOI: 10.1302/2046-3758.112.bjr-2021-0282.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures. METHODS Finite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load. RESULTS Under a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress. CONCLUSION Finite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt. Cite this article: Bone Joint Res 2022;11(2):102-111.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha Seung Yoon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, South Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, South Korea
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, South Korea
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Jang SY, Yoo JI, Cha Y, Ahn YS, Kim JT, Park CH, Choy WS. The Prevalence of Clostridium difficile Colitis and Effect on All-Cause Mortality in Elderly Patients after Hip Fracture Surgery: A Korean Nationwide Cohort Study. Clin Orthop Surg 2022; 14:493-499. [DOI: 10.4055/cios20068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Young-Sun Ahn
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
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Cha Y, Yoo JI, Kim JT, Park CH, Choy WS. How to Solve Anatomical Mismatch in Fixation of Acetabular Fractures Using an Anatomical Quadrilateral Surface Plate. Clin Orthop Surg 2022; 15:338-342. [PMID: 37008975 PMCID: PMC10060771 DOI: 10.4055/cios22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
The anatomical quadrilateral surface buttress plate developed for the quadrilateral surface in an acetabular fracture, a type of fracture difficult to reduce using screws and plates due to its thinness, is a useful implant that makes surgical treatment easier. However, the anatomical structure is different for each patient, and it often does not match the contour of this plate, making detailed bending difficult. Here, we introduce a simple method for controlling the degree of reduction using this plate.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Jang SY, Cha Y, Kim KJ, Kim HY, Choy WS, Koo KH. Nested Case Control Study on the Risk of Suicide Death in Elderly Patients with Pelvic Fractures Using a Nationwide Cohort. Clin Orthop Surg 2022; 14:344-351. [PMID: 36061852 PMCID: PMC9393277 DOI: 10.4055/cios21190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this study was to investigate the incidence rate of suicide deaths in elderly patients with pelvic fractures using a nationwide database and to analyze change in the risk of suicide death overtime after pelvic fractures compared to controls. Methods We used the National Health Insurance Service-Senior cohort (NHIS-Senior) of South Korea. Cases and controls were matched for sex, age, history of hospital admission within 1 year, and presence of depression on the date of suicide death. Controls were collected by random selection at a 1 : 5 ratio from patients at risk of becoming cases when suicide cases were collected. Incident pelvic fractures were identified from the NHIS-Senior as follows: first admission during the observational period (2002–2015) to an acute care hospital with a diagnostic code of International Statistical Classification of Diseases and Related Health Problems, 10th revision S321, S322, S323, S324, S325, or S328 and age 65–99 years. Conditional logistic regression analysis was performed to evaluate the association between pelvic fractures and the risk of suicide death. Results A total of 2,863 suicide cases and 14,315 controls were identified. Suicide case patients had been more frequently exposed to steroids (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21–1.45), benzodiazepines (OR, 1.76; 95% CI, 1.61–1.93), and non-steroidal anti-inflammatory drugs (OR, 1.18; 95% CI, 1.07–1.29). Pelvic fractures within 1 year from the date of suicide death were statistically significantly associated with increased risk of suicide (adjusted OR [AOR], 2.65; 95% CI, 1.29–5.45; p = 0.008) compared to controls. The risk of suicide death declined as the incidence date of pelvic fracture was more remote from the date of suicide death: AORs of 2.59 (95% CI, 1.33–5.04; p = 0.005) within 2 years and 2.13 (95% CI, 1.15–3.95; p = 0.017) within 3 years. However, there was no statistical significance in the increased risk of suicide death for pelvic fractures that had occurred ≥ 4 years ago (p > 0.05). Conclusions Pelvic fractures in the elderly population increased the risk of suicide death within 3 years, suggesting the need for psychiatric support among elderly patients with pelvic fractures.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
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Yoo JI, Jang SY, Cha Y, Choy WS, Koo KH. Comparison of Mortality, Length of Hospital Stay and Transfusion between Hemiarthroplasty and Total Hip Arthroplasty in Octo- and Nonagenarian Patients with Femoral Neck Fracture: a Nationwide Study in Korea. J Korean Med Sci 2021; 36:e300. [PMID: 34811975 PMCID: PMC8608921 DOI: 10.3346/jkms.2021.36.e300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65-79 years (non-octogenerian) and patients aged ≥ 80 years (octogenarian). METHODS We identified elderly (aged ≥ 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery. RESULTS The 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20-3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00-6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21-3.18; P = 0.006) within 60-days. CONCLUSIONS In patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
BACKGROUND The aim of this study was to assess the prevalence of dementia as an underlying disease in elderly patients with hip fracture, to investigate the effect of dementia on postoperative mortality after surgery of hip fracture, and to analyze the differences in postoperative mortalities according to the severity of dementia through subgroup analysis. METHODS This study selected 2,346 elderly patients who were diagnosed with unilateral intertrochanteric or femoral neck fractures who underwent surgery between January 2004 and December 2018. The patients were classified into the non-dementia group (2,196 patients) and dementia group (150 patients; no-medication [66 patients] and medication [84 patients] subgroups). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the groups. A univariate regression test was performed using age, sex, diagnosis, surgery type, and Charlson's comorbidity index (CCI), as these variables had P values of < 0.10. Multivariate regression analysis was performed to identify independent risk factors associated with mortality. RESULTS The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were 1.8%, 3.8%, 5.6%, 8.9%, and 13.6%, respectively, in the non-dementia group, and 2%, 7.3%, 14%, 19.3%, and 24%, respectively, in the dementia group (P = 0.748, P = 0.048, P < 0.001, P < 0.001, and P = 0.001). The factors that affected the 1-year mortality were age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.08; P < 0.001), sex (OR, 2.68; 95% CI, 2.07-3.47; P < 0.001), CCI (OR, 1.34; 95% CI, 1.23-1.47; P < 0.001), and dementia (OR, 1.70; 95% CI, 1.46-1.08; P = 0.016). In subgroup analysis, severity of dementia influenced the 6-month mortality (OR, 1.41; 95% CI, 1.70-2.01; P = 0.018), and 1-year mortality (OR, 1.30; 95% CI, 1.17-1.90; P = 0.027). CONCLUSION In elderly hip fracture patients, the comparison between patients with and without dementia revealed that dementia was an independent risk factor for mortality at a minimum of 1 year of follow-up, and the severity of dementia in hip fracture patients was a risk factor for mortality within 6 months and 1 year, postoperatively.
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Affiliation(s)
- Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jiyoon Lee
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Jang SY, Cha Y, Lee JC, Kim H, Kim KJ, Choy W. Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study. J Korean Med Sci 2021; 36:e225. [PMID: 34519185 PMCID: PMC8438184 DOI: 10.3346/jkms.2021.36.e225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. METHODS We used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. RESULTS Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57-4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04-2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74-2.77; P = 0.282). CONCLUSION There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Je Chan Lee
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hayong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Cha Y, Song JU, Yoo JI, Park KH, Kim JT, Park CH, Choy WS. Improved control over implant anchorage under the use of the femoral neck system for fixation of femoral neck fractures: a technical note. BMC Musculoskelet Disord 2021; 22:621. [PMID: 34256741 PMCID: PMC8278696 DOI: 10.1186/s12891-021-04497-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/29/2021] [Indexed: 01/18/2023] Open
Abstract
Background The depth of bolt in Femoral neck system (FNS, DePuy Synthes, Oberdorf, Switzerland) is difficult to finely control as the length of the bolt is in units of 5 mm. Thus, this study introduces a method to control the depth of FNS bolt in analogue scale in patients with femoral neck fracture. Methods By the technique of control of reaming and retraction of bolt, the tip of implant could be positioned close to subchondral bone without harming it. The position of implant tip in four cases in which the introduced technique was applied was compared to that of eight cases where the standard technique was performed. Results The average tip-apex distance measured in the cases that underwent surgery using the suggested technique in this study was statistically significantly shorter than that measured in the cases that underwent surgery under manufacturer guidelines. Conclusion Even though the bolt of FNS is manufactured in the unit of 5 mm, the technique proposed in this study helps surgeons to adjust the depth of bolt for the fixation of femoral neck fracture using FNS.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ji-Ung Song
- Department of Orthopaedic Surgery, Chamjoen Hospital, Gwangju, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Ki Hoon Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, 16499, Suwon-si, Gyeonggi-do, South Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, 16499, Suwon-si, Gyeonggi-do, South Korea.
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Min K, Beom J, Kim BR, Lee SY, Lee GJ, Lee JH, Lee SY, Won SJ, Ahn S, Bang HJ, Cha Y, Chang MC, Choi JY, Do JG, Do KH, Han JY, Jang IY, Jin Y, Kim DH, Kim DH, Kim IJ, Kim MC, Kim W, Lee YJ, Lee IS, Lee IS, Lee J, Lee CH, Lim SH, Park D, Park JH, Park M, Park Y, Ryu JS, Song YJ, Yang S, Yang HS, Yoo JS, Yoo JI, Yoo SD, Choi KH, Lim JY. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Ann Rehabil Med 2021; 45:225-259. [PMID: 34233406 PMCID: PMC8273721 DOI: 10.5535/arm.21110] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | | | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangwoo Ahn
- Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youri Jin
- Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Jong Kim
- Howareyou Rehabilitation Clinic, Seoul, Korea
| | - Myung Chul Kim
- Department of Physical Therapy, Eulji University, Seongnam, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Jung Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - In Seok Lee
- Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - JungSoo Lee
- Department of Rehabilitation Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chang-Hyung Lee
- Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Park
- Department of Nursing, Konkuk University, Chungju, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, Hanyang University, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Song
- Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jun-il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Yoo JI, Jang SY, Cha Y, Park CH, Kim JT, Oh S, Choy W. Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study. J Korean Med Sci 2021; 36:e127. [PMID: 34002547 PMCID: PMC8129618 DOI: 10.3346/jkms.2021.36.e127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort. METHODS Our study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality. RESULTS A total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45-1.8; P < 0.001). CONCLUSION Current use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.
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Affiliation(s)
- Jun Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Suk Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jung Taek Kim
- Department of Orthopaedic Surgery, Ajou Medical Center, Suwon, Korea
| | - Seunghak Oh
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Cha Y, Jang SY, Yoo JI, Choi HG, Hwang JW, Choy W. Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study. J Korean Med Sci 2021; 36:e87. [PMID: 33821594 PMCID: PMC8021974 DOI: 10.3346/jkms.2021.36.e87] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/14/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. METHODS This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. RESULTS In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12-1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43-1.91; P < 0.001), respectively, compared to past non-users. CONCLUSION In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Suk Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Jun Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.
| | - Hyo Gil Choi
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jeong Won Hwang
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Yoo JI, Cha Y, Kwak J, Kim HY, Choy WS. Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures. Hip Pelvis 2020; 32:170-181. [PMID: 33335865 PMCID: PMC7724026 DOI: 10.5371/hp.2020.32.4.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/11/2023] Open
Abstract
Basicervical femoral neck fracture is an uncommon fracture that accounts for only 1.8% of all proximal femoral fractures. Previous studies have recommended that the choice of implant to treat this fracture should be similar to that of intertrochanteric fracture. However, in previous studies on basicervical fractures, the definition and treatment results of these fractures were different, and there were also debates on the implant that had to be used. Therefore, the purpose of this study was to review the studies that performed surgical treatment of basicervical femoral fractures and to assess the definition of basicervical fracture, the use of implants, and failure rates and clinical results. Study selection was based on the following inclusion criteria: (1) treatment outcome for basicervical femoral neck fracture was reported; and (2) dynamic hip screw, proximal femoral nail, or multiple screw fixation was used as treatment. PubMed Central, OVID MEDLINE, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to March, 2020 with English language restriction. A total of 15 studies were included in this study. Differences were found in the definition of basicervical fracture, treatment results, rehabilitation protocol, and fixation failure rate. Definitions and treatment methods for basicervical fractures varied, and treatment outcomes also differed among the enrolled studies. Further research is needed that would be restricted to those fractures that conform to the definition of basicervical fracture.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joonhyeok Kwak
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Yasin O, Vaidya V, Tri J, Van Zyl M, Ladejobi A, Xiao P, Han J, Scheuermann C, Bush J, Taubel R, Pedersen J, Yngsdal L, Asirvatham S, Cha Y. Activation pattern during his pacing: how close are we to normal physiology? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction.
Purpose
Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing.
Methods
Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration <120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation.
Results
Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV.
Conclusion
Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic
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Affiliation(s)
- O Yasin
- Mayo Clinic, Rochester, United States of America
| | - V Vaidya
- Mayo Clinic, Rochester, United States of America
| | - J Tri
- Mayo Clinic, Rochester, United States of America
| | - M Van Zyl
- Mayo Clinic, Rochester, United States of America
| | - A Ladejobi
- Mayo Clinic, Rochester, United States of America
| | - P Xiao
- Mayo Clinic, Rochester, United States of America
| | - J Han
- Mayo Clinic, Rochester, United States of America
| | - C Scheuermann
- Boston Scientific, Minneapolis, United States of America
| | - J Bush
- Boston Scientific, Minneapolis, United States of America
| | - R Taubel
- Mayo Clinic, Rochester, United States of America
| | - J Pedersen
- Mayo Clinic, Rochester, United States of America
| | - L Yngsdal
- Mayo Clinic, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Rochester, United States of America
| | - Y Cha
- Mayo Clinic, Rochester, United States of America
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Jang SY, Ha YC, Cha Y, Kim KJ, Choy W, Koo KH. The Influence of Renal Dialysis on All-Cause Mortality in Older Patients with Hip Fracture: a Korean Nationwide Cohort Study. J Korean Med Sci 2020; 35:e190. [PMID: 32567258 PMCID: PMC7308139 DOI: 10.3346/jkms.2020.35.e190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the all-cause mortality rate over time after elderly hip fracture in end-stage renal disease (ESRD) patients with dialysis, using a Korean nationwide claims database. METHODS This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Senior cohort (NHIS-Senior). The NHIS-Senior (total of 588,147 participants) was constructed by 10% random sampling and was designed to represent the elderly living in Korea. Subjects were patients aged 65-99 years who underwent surgical treatment for femoral neck fractures or intertrochanteric fractures. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to measure associations between renal dialysis and cumulative mortality in various time frames. RESULTS The total number of patients included in this study was 16,818. These patients were divided into two groups: 116 (0.69%) in the dialysis group and 16,702 (99.31%) in the no-dialysis group. The mean length of hospital stay was 43.87 ± 48.45 days in the dialysis group and 36.29 ± 37.49 days in the no-dialysis group (P = 0.095). The effect of renal dialysis on all-cause mortality was 2.29-fold (aRR; 95% CI, 1.29-4.06; P = 0.005) within 30 days and 1.72-fold (aRR; 95% CI, 1.34-2.21; P < 0.001) within 1-year after hip fracture compared to the no-dialysis group. And, the effect of renal dialysis of in-hospital mortality was 2.72-fold (aRR; 95% CI, 1.71-4.33; P < 0.001) compared to the no-dialysis group. CONCLUSION Elderly patients who underwent dialysis have very high mortality rates after hip fracture. Therefore, it is considered that postoperative care through multidisciplinary management and understanding of pathophysiology for the ESRD patients is necessary.
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Affiliation(s)
- Suk Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.
| | - Kap Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cha Y, Yoo JI, Kim JT, Park CH, Choy W, Ha YC, Koo KH. Disadvantage during Perioperative Period of Total Hip Arthroplasty Using the Direct Anterior Approach: a Network Meta-Analysis. J Korean Med Sci 2020; 35:e111. [PMID: 32383362 PMCID: PMC7211512 DOI: 10.3346/jkms.2020.35.e111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze complications of complete hip arthroplasty through systematic review and network meta-analysis of comparative studies of direct anterior approach (DAA), anterolateral approach (LA), and posterolateral approach (PA). METHODS Prospective randomized controlled trials (RCTs) or quasi-experimental designs evaluating clinical outcomes of DAA, LA, and PA for complete hip arthroplasty are valid if they meet the following criteria: 1) Comparison of clinical outcomes between the three methods for main complete hip arthroplasty (total hip arthroplasty, THA); 2) Compared at least one of the following outcomes: blood loss, operating time, and transfusion volume; 3) Sufficient data were available to extract and pool, i.e., mean reported, standard deviation and number of subjects. A network meta-analysis was used to determine the results of treatment across various surgical approaches. Indirect comparisons between the two surgical approaches was made by borrowing details from the standard comparator (i.e., the posterior approach). RESULTS Eight prospective RCTs were included in the meta-analysis of the network. The operation time of the LA was longer than that of PA (standardized mean difference [SMD], 0.96; 95% confidence interval [CI], 0.74-1.18; P < 0.001). DAA also had significantly longer operation time than PA (SMD, 0.45; 95% CI, 0.24-0.66; P < 0.001). However, blood loss of the DAA was the highest compared to other approaches (SMD, 0.60; 95% CI, 0.39-0.82; P = 0.002). CONCLUSION When performing THA with DAA, we should pay attention to increased operation time and blood loss.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jun Il Yoo
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.
| | - Jung Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Jang SY, Cha Y, Yoo JI, Yu YT, Kim JT, Park CH, Choy W. Effect of Pneumonia on All-cause Mortality after Elderly Hip Fracture: a Korean Nationwide Cohort Study. J Korean Med Sci 2020; 35:e9. [PMID: 31920015 PMCID: PMC6955432 DOI: 10.3346/jkms.2020.35.e9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/15/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea. METHODS The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality. RESULTS During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14-3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01-3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61-3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14-2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89-11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08-6.46) in those aged 70-79 years, 3.29 (95% CI, 2.81-3.86) in those aged 80-89 years and 2.02 (95% CI, 1.52-2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01-4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80-3.83) in women pneumonia patients. CONCLUSION The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.
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Affiliation(s)
- Suk Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.
| | - Young Tak Yu
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jung Taek Kim
- Department of Orthopaedic Surgery, Ajou University Medical Center, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Yasin O, Kella D, Isath A, Padmanabhan D, Hodge D, Cochuyt J, Mulpuru S, Cha Y, Friedman P. P2851Transvenous lead placement in the setting of venous obstruction: outcomes of tunneling technique versus venoplasty. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Venous stenosis is a well-recognized complication of transvenous leads when patients require lead revisions or device upgrade. In these cases, balloon venoplasty or alternative venous access with subcutaneous tunneling can be performed.
Purpose
Compare the outcomes of venoplasty vs. tunneling in patients requiring additional transvenous lead implantation.
Methods
A single center retrospective cohort study of all patients undergoing lead implantation/revision requiring venoplasty or tunneling from 2005–2017. Chi-squared and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables.
Results
Ninety five patients met our inclusion criteria (60 venoplasty & 35 tunneling). There was no difference in procedure success rates (p-value=0.98). Tunneling was associated with less fluoroscopy time but higher incidence of acute complications (0% vs. 23%, p-value=0.002) most requiring invasive intervention and/or blood product transfusion. Long term outcomes were comparable and related to lead failure or infection.
Outcomes for tunneling vs. venoplasty Variable Tunneling (n=35) Venoplasty (n=60) p-value Age Y 67 (23–84) 70 (29–91) 0.25 Male (%) 24 (69%) 41 (68%) 0.98 Number of existing leads 2.1 (1–4) 2.4 (0–4) 0.1 Age of oldest lead 7.0 (0–21) 7.2 (0–33) 0.73 Number of new leads 1.2 (1–3) 1.4 (1–3) 0.26 Fluoroscopy time (SD) min 29.2 (21.3) 39.7 (21.5) 0.012 Procedure success (%) 35 (100%) 55 (92%) 0.9 Acute complications (%) 8 (23%)1 0 (0%) 0.0002 Pocket hematoma/bleed 4 (11%)2 Hemothorax 2 (6%)3 Pericarditis 1 (3%) Lead compromise 1 (3%) Follow up M 18 (0–76) 28 (0–98) N/A Long term lead issues (%) 6 (17%) 10 (17%) 0.95 Long term complication requiring intervention 4 (11%) 8 (13%) N/A Procedure success: functional lead placed as a result of venoplasty or tunneling. 1Two patients required blood products. 2Two patients required invasive intervention. 3One patient required chest tube and the other ICU admission.
Conclusions
Balloon venoplasty is associated with similar rates of success and a less incidence of acute complications when compared subcutaneous tunneling.
Acknowledgement/Funding
NIH T32 Training Grant HL07111-40
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Affiliation(s)
- O Yasin
- Mayo Clinic, Rochester, United States of America
| | - D Kella
- Piedmont Heart Institute, Atlanta, United States of America
| | - A Isath
- St Luke's Roosevelt Hospital, New York, United States of America
| | | | - D Hodge
- Mayo Clinic, Rochester, United States of America
| | - J Cochuyt
- Mayo Clinic, Rochester, United States of America
| | - S Mulpuru
- Mayo Clinic, Rochester, United States of America
| | - Y Cha
- Mayo Clinic, Rochester, United States of America
| | - P Friedman
- Mayo Clinic, Rochester, United States of America
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Park H, Pyo J, Hong S, Cho M, Cha Y. P1.09-27 Interobserver Variation in the Cytological Diagnosis of Pulmonary Adenocarcinoma Presenting with Ground-Glass Opacity Nodules. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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